Wednesday March 11, 2020
Leading Italian public health expert Nino Cartabellotta offers a stark perspective on the coronavirus outbreak in Italy.
Rome, Italy - A few minutes after Italy announced unprecedented travel restrictions on its 60 million people on Monday to control the deadly coronavirus outbreak in the country, Al Jazeera talked to Nino Cartabellotta, a leading Italian public health expert, professor and president of Gruppo Italiano per la Medicina Basata sulle Evidenze or GIMBE - Italy's Group for Evidence-based Medicine.
"Finally, the decision has been taken," Cartabellotta said in an interview by phone, welcoming the extension of the quarantine zone to all of the country.
"It was about time. This is the only way we can tackle the spread of the virus effectively."His research institute has been gathering data and following the coronavirus outbreak since its onset in China and belongs to a taskforce recently set up to advise Italy's Ministry of Health.
Cartabellotta has been vocal throughout the epidemic, calling for strict containment measures to be implemented since late February.
Al Jazeera: How has the virus has spread so quickly?
Nino Cartabellotta: We noticed that the virus had first extended across the Hubei province, then to its provincial neighbours, and eventually across China. We knew the same dynamic would have repeated in other countries. The more days that passed, the clearer it became that the virus would have reached everywhere, thanks to its high transmissibility and through asymptomatic cases.
The virus arrived in Italy most likely in the first or second week of January, much before the closure of the country's air traffic from and to China on January 30, when people still thought suspending flights might have spared us the infection.
Al Jazeera: Some say the current lockdown should have been implemented earlier. Has a delay made the situation more critical?
Cartabellotta: Following the announcement of the first few cases in Italy, we immediately understood we would have gone through such a vast epidemic. The COVID-19 outbreak was driven by the spread in hospitals in Italy. In such cases, the number of infected patients skyrockets very fast.
Before Monday, measures had been taken in fits and starts because of political and economic factors amid an attempt to protect the national economy, without considering in full all the evaluations that we had presented at the institutional level.
Italian politics took a wait-and-see approach. More or less rigorous measures have been taken based on what was unfolding on the ground. But the virus doesn't work this way. The virus moves extremely quickly.
We would have needed to take such draconian containment measures for the whole country since March 1. It doesn't make sense to put regional, provincial or city borders in such a situation. A policy of procrastination is not a solution amid an epidemic.
[Courtesy: Nino Cartabellotta]
But Europe is just doing the same. There hasn't been any coordination at the European level on this issue, no preparation plan in case of a pandemic neither at the national nor at the bloc level. I'm not aware of any European country having a plan against a pandemic ready to be rolled out.
Policies like those implemented by China's ruling Communist Party that closed down Hubei for about three weeks are those that really pay off at the moment. We are seeing their positive results as China is now getting out of the tunnel. All other partial containment measures are not proportioned to the speed of the virus.
Politics hasn't understood how this virus spreads yet. Each country thought of itself as being immune from the infection, as if the virus would have never reached its borders.
Decisions are simply taken as events precipitate.
Al Jazeera: How will Italy's health system cope?
Cartabellotta: I am very worried about the resilience of our healthcare system. All measures of social containment are meant to slow down the spread of the virus and distribute the emergence of new cases over a longer period. This could give the health system time to prepare. But this was not possible to do in Lombardy and I fear that we won't be able to prevent the infection escalation also in the other regions.
Italian citizens have been completely undisciplined, the government has been playing at drawing new hypothetical borders on a map, depending on the daily increment of the number of cases. We never acted with a clear goal of preventing the infection from spreading. We have already problems in the south to carry out normal healthcare routines, let's not even talk about coping with an epidemic of this sort. I fear we will witness a very high number of deaths.
Al Jazeera: How would you characterise the current situation?
Cartabellotta: We have been seeing an ever-growing increase of the number of cases in other regions as of March 1. So far, there hasn't been any positive effect resulting from the containment measures previously implemented. Based on the data we gathered, we are recording a daily increase of the cases by 25 percent. Until the moment that the containment measures start showing some results, this rate will stay pretty much stable, unless a new vast outbreak emerges.
Lethality in Italy is higher than China because we are only doing swab tests on patients with symptoms, while we have estimated that asymptomatic cases might be around 15,000 at the moment. We are just scratching the surface of the virus diagnostics here. Also, the 6.1 percent lethality rate registered in Lombardy, shows that the healthcare system no longer holds. More people are dying because the system is saturated.
Al Jazeera: Are you suggesting containment measures are ineffective?
Cartabellotta: Draconian measures are always effective. Still, we cannot predict to what extent, as we don't know how widespread the virus is, especially in Italy's central and southern regions. It is important that other countries understand that the later they implement severe measures, the fewer the results. Every day of delay creates more infected, patients in need of ICUs and deaths. China taught us this.
Al Jazeera: Has Italy ever dealt with a similar crisis?
Cartabellotta: Italy never faced such an epidemic in recent history. This is not comparable to what happened during the 2003 SARS outbreak. There is a generational lack of preparation to fight and handle a pandemic. The absence of a plan set in place will also completely wear out our public healthcare system, which has been already severely hit by cuts and lack of investment in the past decade.
Al Jazeera: What should be done in case containment measures do not work?
Cartabellotta: There are no other measures available. Everyone should stay home and obediently and completely stick to all the behavioural rules given by the government. European countries should also implement our stringent measures as soon as possible, as a similar destiny is coming to their doors. The longer we wait the higher the number of deaths.